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Biomedical subjects

R L Goldenberg

Publications and source records attributed to R L Goldenberg.

At least 235 records · Page 13Linked to original sources
PubMed1987

Fetal deaths in Alabama, 1974-1983: a birth weight-specific analysis.

Birth weight-specific fetal death rates were evaluated for Alabama for the years 1974-1983. The fetal death rate for the total low birth weight group improved less than 20% during the decade, whereas the fetal death rate for the 2500-3999-g birth weight group improved 40%, and the fetal death rate for the group of 4000 g or more improved 71%. By 1983, 76% of all stillbirths weighed less than 2500 g, compared with 66% in 1974. In contrast, in both years, only about 7% of live births weighed less than 2500 g. This study suggests that increased reporting of stillbirths of less than 500 g has contributed to the recent apparent lack of improvement in stillbirth rates in Alabama.

Alabama↗
PubMed1985

Low birth weight, intrauterine growth retardation, and preterm delivery.

The relationship between low birth weight, intrauterine growth retardation, and preterm delivery in infants born at a perinatal center is described. Between 20% and 30% of infants born weighing 500 to 2000 gm and nearly 50% of infants born weighing 2001 to 2750 gm had intrauterine growth retardation. For infants within the same low-birth weight group, infants with intrauterine growth retardation had one half to one sixth of the neonatal mortality rate of non-growth-retarded infants. However, only in the 501 to 1000 gm group did the difference in mortality between infants with and without intrauterine growth retardation substantially influence the composition of the group of survivors.

Birth Weight↗
PubMed1985

Neonatal mortality in infants born weighing 501 to 1000 grams. The influence of changes in birth weight distribution and birth weight-specific mortality rates on neonatal survival.

We analyzed changes over time in neonatal mortality rates for infants born weighing 501 to 1000 gm. The decline in total mortality in this weight group due to improved small-group, birth weight-specific mortality was contrasted to the increase in mortality caused by changes in the birth weight distribution resulting from the care of smaller infants. Had the birth weight distribution remained unchanged, the total improvement in neonatal mortality for the entire 501 to 1000 gm group would have been substantially greater.

Alabama↗
PubMed1985

Gestational age and the management of preterm labor in obstetric programs.

The gestational age at which obstetric training programs aggressively manage and attempt to salvage preterm vertex fetuses in distress was determined by survey. More than half the programs initiate fetal monitoring and perform cesarean section for certain cases of fetal distress by 26 weeks gestational age. By 28 weeks gestational age, most programs consistently perform a cesarean delivery for a vertex fetus in distress. Management practices in university training programs appear to be more aggressive than those in nonuniversity programs. Not all programs--either within or outside the university--try aggressively to salvage fetuses in distress at 28 weeks gestational age or more, however, despite the excellent chance for survival and normal development.

Cesarean Section↗
PubMed1985

Vital statistics data as a measurement of perinatal regionalization in Alabama, 1970 and 1980.

Although regionalization of perinatal health care services has received credit for much of the recent improvement in neonatal mortality, until now no measurement of regionalization has been proposed. The measurement presented in this paper--the average of the percentage of infants of very low birthweight and neonatal deaths occurring among residents of a geographic area at a perinatal center--provides a means of comparing the extent of perinatal regionalization in various geographic areas and time periods. Despite continued disparities in the degree of regionalization from one perinatal district to another, Alabama's perinatal system became substantially regionalized from 1970 to 1980. The lower mortality for infants of very low birthweight born at a perinatal center suggests that if Alabama were more completely regionalized, its neonatal mortality would be improved.

Alabama↗
PubMed1984

Apgar scores and umbilical arterial pH in preterm newborn infants.

One- and five-minute Apgar scores and umbilical cord arterial pH values were compared in preterm newborn infants of various gestational ages. The more premature the infant, the more likely the Apgar score was low in the presence of a pH greater than or equal to 7.25. Conversely, the closer to term, the more frequently an infant with a pH of less than 7.25 had an Apgar score of greater than or equal to 7. Therefore, in preterm infants, there is little congruity between the Apgar score and umbilical cord pH. Based on these findings, it is not appropriate to label preterm newborn infants as asphyxiated based on a low Apgar score.

Apgar Score↗
PubMed1984

Survival of infants with low birth weight and early gestational age, 1979 to 1981.

A chart for displaying neonatal survival data regarding low birth weight and early gestational age is presented. Survival data at two institutions for infants with low birth weight and early gestational age are compared. This format is useful for student and resident teaching, for counseling parents-to-be about potential outcomes, for consulting with out-of-hospital physicians who request advice about maternal-fetal transport, and most important, for helping to make the crucial decisions necessary during the management of labor and delivery of infants with low birth weight and early gestational age.

Black or African American↗
PubMed1984

The unanticipated breech presentation in labor.

In summary, the obstetrician often cannot anticipate the appearance of a woman with a breech fetus in labor, and, in the majority of instances, a woman will be in labor before the diagnosis is made. To obtain the best outcome with both preterm and term breech fetuses, the appropriate data must be obtained rapidly, and a plan of management based on this data must be developed. Management protocols outlined in this article, although not ensuring a good outcome in every instance, most often will result in the delivery of a healthy newborn. We should emphasize again that if the information described above is not available, then the safest course in most instances is delivery by cesarean section.

Body Weight↗
PubMed1984

Delay in delivery: influence of gestational age and the duration of delay on perinatal outcome.

The potential benefits to be gained in neonatal survival and freedom from serious morbidity by delaying delivery at various gestational ages was explored by examining the results of studies of neonatal mortality and subsequent morbidity published from 1978 and 1984. The major benefits were found to occur between 24 and 27 weeks' gestational age. In general, little benefit was found in delaying delivery after 34 weeks' gestational age.

Birth Weight↗
PubMed1983

Neonatal deaths in Alabama. III. Out-of-hospital births, 1940-1980.

Out-of-hospital births in Alabama are characterized with special emphasis on the period from 1970 to 1980. Women having an out-of-hospital birth were more likely to be nonwhite, aged greater than or equal to 35, and multiparous and to have little or no prenatal care. However, within the group of women having out-of-hospital delivery, characteristics which predicted neonatal death included being white, aged less than 20, primiparous, and unmarried and having little or no prenatal care. Both the risk factors for and outcomes of out-of-hospital birth differed markedly by race. In all, out-of-hospital births, which declined from 25% to 0.5% of all births from 1940 to 1980, were associated with a twofold increase in neonatal mortality. The major care provider for out-of-hospital births, the "granny" midwife, was found to have little knowledge about, or ability to provide, modern obstetric care. High-risk status of the patients, limited capability of the care-givers, and lack of appropriate medical resources are suggested as the likely reasons for the excess neonatal mortality in out-of-hospital births.

Adult↗
PubMed1983

Neonatal deaths in Alabama. II. Policy and research implications derived from a comparison of birth weight-specific state and medical center neonatal mortality rates.

An analysis of Alabama's recent neonatal mortality rate was performed to answer questions pertaining to projected changes in the neonatal mortality rate in the next decade. With current technology these questions include: (1) Can the current decline in the neonatal mortality rate continue? (2) Which infants not now surviving are potentially able to be saved? (3) What types of new programs may further reduce the neonatal mortality rate? (4) For which infants may research provide technology leading to further reductions in the neonatal mortality rate? In this analysis, birth weight-specific neonatal mortality rates for Alabama were compared with the lowest birth rate-specific neonatal mortality rates achieved in perinatal centers. Specific causes of neonatal death for each birth weight group were determined. Data suggest that 20% of current neonatal deaths would be preventable with available technology through expanded regionalization of perinatal care for infants born weighing less than 2,500 gm. Since lethal congenital anomalies cause the majority of neonatal deaths in infants born weighing greater than 2,499 gm, there is apparently little room for an improved neonatal mortality rate in this group. Without successful research leading to a reduction in preterm delivery rates, a reduction in lethal congenital anomalies or better survival of low-birth weight infants. Alabama's neonatal mortality rate is likely to level off at five to six per 1,000.

Alabama↗
PubMed1983

Neonatal deaths in Alabama, 1970-1980: an analysis of birth weight- and race-specific neonatal mortality rates.

Alabama birth and death certificate tapes for the years 1970-1980 were linked and analyzed to determine race-specific birth weight and neonatal mortality rate distributions. Changes which occurred over time were evaluated. Our analyses demonstrated that there were no substantial changes in birth weight distributions which could account for the nearly 50% reduction in the neonatal mortality rate in Alabama during this period. Birth weight changes did result in a 12% decrease in the white neonatal mortality rate but resulted in no decrease in the nonwhite neonatal mortality rate. All other improvement in the neonatal mortality rate is attributed to better survival within birth weight groups. Eighty percent of the reduction in the neonatal mortality rate during this period of time occurred in low-birth weight infants with most of the reduction found in infants weighing between 1,000 and 2,000 gm. Improvements in the quality of medical care and better access to medical care through regionalization of perinatal services, especially for low-birth weight infants, are suggested as the major reasons for this improvement.

Black or African American↗